Development and Validation of the Geriatric Anxiety Inventory

Background: Anxiety symptoms and anxiety disorders are highly prevalent among elderly people, although infrequently the subject of systematic research in this age group. One important limitation is the lack of a widely accepted instrument to measure dimensional anxiety in both normal old people and old people with mental health problems seen in various settings. Accordingly, we developed and tested of a short scale to measure anxiety in older people. Methods:We generated a large number of potential items de novo and by reference to existing anxiety scales, and then reduced the number of items to 60 through consultation with a reference group consisting of psychologists, psychiatrists and normal elderly people. We then tested the psychometric properties of these 60 items in 452 normal old people and 46 patients attending a psychogeriatric service. We were able to reduce the number of items to 20. We chose a 1-week perspective and a dichotomous response scale. Results: Cronbach's alpha for the 20-item Geriatric Anxiety Inventory (GAI) was 0.91 among normal elderly people and 0.93 in the psychogeriatric sample. Concurrent validity with a variety of other measures was demonstrated in both the normal sample and the psychogeriatric sample. Inter-rater and test-retest reliability were found to be excellent. Receiver operating characteristic analysis indicated a cut-point of 10/11 for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in the psychogeriatric sample, with 83% of patients correctly classified with a specificity of 84% and a sensitivity of 75%. Conclusions: The GAI is a new 20-item self-report or nurse-administered scale that measures dimensional anxiety in elderly people. It has sound psychometric properties. Initial clinical testing indicates that it is able to discriminate between those with and without any anxiety disorder and between those with and without DSM-IV GAD

Psychological characteristics of religious delusions

Purpose Religious delusions are common and are considered to be particularly difficult to treat. In this study we investigated what psychological processes may underlie the reported treatment resistance. In particular, we focused on the perceptual, cognitive, affective and behavioural mechanisms held to maintain delusions in cognitive models of psychosis, as these form the key treatment targets in cognitive behavioural therapy. We compared religious delusions to delusions with other content. Methods Comprehensive measures of symptoms and psychological processes were completed by 383 adult participants with delusions and a schizophrenia spectrum diagnosis, drawn from two large studies of cognitive behavioural therapy for psychosis. Results Binary logistic regression showed that religious delusions were associated with higher levels of grandiosity (OR 7.5; 95 % CI 3.9–14.1), passivity experiences, having internal evidence for their delusion (anomalous experiences or mood states), and being willing to consider alternatives to their delusion (95 % CI for ORs 1.1–8.6). Levels of negative symptoms were lower. No differences were found in delusional conviction, insight or attitudes towards treatment. Conclusions Levels of positive symptoms, particularly anomalous experiences and grandiosity, were high, and may contribute to symptom persistence. However, contrary to previous reports, we found no evidence that people with religious delusions would be less likely to engage in any form of help. Higher levels of flexibility may make them particularly amenable to cognitive behavioural approaches, but particular care should be taken to preserve self-esteem and valued aspects of beliefs and experiences

Oral abstracts 3: RA Treatment and outcomesO13. Validation of jadas in all subtypes of juvenile idiopathic arthritis in a clinical setting

Background: Juvenile Arthritis Disease Activity Score (JADAS) is a 4 variable composite disease activity (DA) score for JIA (including active 10, 27 or 71 joint count (AJC), physician global (PGA), parent/child global (PGE) and ESR). The validity of JADAS for all ILAR subtypes in the routine clinical setting is unknown. We investigated the construct validity of JADAS in the clinical setting in all subtypes of JIA through application to a prospective inception cohort of UK children presenting with new onset inflammatory arthritis. Methods: JADAS 10, 27 and 71 were determined for all children in the Childhood Arthritis Prospective Study (CAPS) with complete data available at baseline. Correlation of JADAS 10, 27 and 71 with single DA markers was determined for all subtypes. All correlations were calculated using Spearman's rank statistic. Results: 262/1238 visits had sufficient data for calculation of JADAS (1028 (83%) AJC, 744 (60%) PGA, 843 (68%) PGE and 459 (37%) ESR). Median age at disease onset was 6.0 years (IQR 2.6-10.4) and 64% were female. Correlation between JADAS 10, 27 and 71 approached 1 for all subtypes. Median JADAS 71 was 5.3 (IQR 2.2-10.1) with a significant difference between median JADAS scores between subtypes (p < 0.01). Correlation of JADAS 71 with each single marker of DA was moderate to high in the total cohort (see Table 1). Overall, correlation with AJC, PGA and PGE was moderate to high and correlation with ESR, limited JC, parental pain and CHAQ was low to moderate in the individual subtypes. Correlation coefficients in the extended oligoarticular, rheumatoid factor negative and enthesitis related subtypes were interpreted with caution in view of low numbers. Conclusions: This study adds to the body of evidence supporting the construct validity of JADAS. JADAS correlates with other measures of DA in all ILAR subtypes in the routine clinical setting. Given the high frequency of missing ESR data, it would be useful to assess the validity of JADAS without inclusion of the ESR. Disclosure statement: All authors have declared no conflicts of interest. Table 1Spearman's correlation between JADAS 71 and single markers DA by ILAR subtype ILAR Subtype Systemic onset JIA Persistent oligo JIA Extended oligo JIA Rheumatoid factor neg JIA Rheumatoid factor pos JIA Enthesitis related JIA Psoriatic JIA Undifferentiated JIA Unknown subtype Total cohort Number of children 23 111 12 57 7 9 19 7 17 262 AJC 0.54 0.67 0.53 0.75 0.53 0.34 0.59 0.81 0.37 0.59 PGA 0.63 0.69 0.25 0.73 0.14 0.05 0.50 0.83 0.56 0.64 PGE 0.51 0.68 0.83 0.61 0.41 0.69 0.71 0.9 0.48 0.61 ESR 0.28 0.31 0.35 0.4 0.6 0.85 0.43 0.7 0.5 0.53 Limited 71 JC 0.29 0.51 0.23 0.37 0.14 -0.12 0.4 0.81 0.45 0.41 Parental pain 0.23 0.62 0.03 0.57 0.41 0.69 0.7 0.79 0.42 0.53 Childhood health assessment questionnaire 0.25 0.57 -0.07 0.36 -0.47 0.84 0.37 0.8 0.66 0.4

Development and clinical utility of the geriatric anxiety inventory

Although anxiety disorders are highly prevalent in older people, there is no generally accepted scale to measure generalized anxiety symptoms in later life. Accordingly, we undertook the development and initial clinical testing of a new scale that we have called the Geriatric Anxiety Inventory (GAI). We developed the GAI with the intention that it would be able to measure anxiety symptoms in both normal older people and those with anxiety disorders. We generated a large number of potential items de novo and by reference to existing anxiety rating scales. Items were chosen to represent fearfulness, worry, meta-worry (i.e., worry about worry),cognitions about anxiety, somatic symptoms of anxiety, anxious mood and anxiety sensitivity. Through consultation with a reference group of psychiatrists, psychologists and normal older people we reduced the number of draft items to 60. We deliberately minimised the number of somatic anxiety items to avoid confounding by the symptoms of chronic health problems commonly experienced by older people. To maximise usability, we applied a oneweek self-rating perspective and a dichotomous response scale.We then tested the psychometric properties of the 60 items in a group of 452 communityresiding normal older people and 46 patients attending a psychogeriatric service. Items were eliminated from this pool of 60 draft items if they had low item-total correlations, if they were considered potentially confusing to cognitively impaired people, if they were redundant, and if they were reverse scored. By these means, we were able to reduce the number of items to 20. These items all had item-total correlations of 0.39 or above. Test-retest reliability (Pearsons r) after a one-week interval was 0.91 (

Unusual dual-emissive heteroleptic iridium complexes incorporating TADF cyclometalating ligands

Five new neutral heteroleptic iridium(III) complexes IrL2(pic) (2–6) based on the archetypical blue emitter FIrpic have been synthesised. The cyclometallating ligands L are derived from 2-(2,6-F2-3-pyridyl)-4-mesitylpyridine (7), 2-(3-cyano-2,6-F2-phenyl)-4-mesitylpyridine (8), 2-(2,6-F2-phenyl)-4-[2,7-(HexO)2-9H-carbazol-9-yl]pyridine (9), 2-(2,6-F2-3-pyridyl)-4-[2,7-(HexO)2-9H-carbazol-9-yl]pyridine (10) and 2-(3-cyano-2,6-F2-phenyl)-4-[2,7-(HexO)2-9H-carbazol-9-yl]pyridine (11) for complexes 2, 3, 4, 5 and 6, respectively. The carbazole-functionalised ligands 9–11 show weak thermally activated delayed fluorescence (TADF) in solution. Complexes 5 and 6 reveal dual emission in polar solvents. A broad charge transfer (CT) band appears and increases in intensity relative to the higher energy emission band as solvent polarity is increased. The dual emission occurs when the energy of the ligand 3CT state is comparable to that of the 3MLCT state of the complex, resulting in fast interconversion between the two. Assignment of the ligand TADF and dual emission properties is supported by hybrid density functional theory (DFT) and time dependent DFT (TD-DFT) calculations. Phosphorescent organic light emitting devices (PhOLEDs) have been fabricated using these complexes as sky-blue emitters, and their performance is compared to devices using FIrpic and the previously reported complex IrL2(pic) 1 (L from the 2-(2,6-F2-phenyl)-4-mesitylpyridine ligand). For identical device structures, the device containing the carbazole complex 4 performs best out of the seven complexes. The dual emission observed in solution for complexes 5 and 6 is not observed in their devices

The OMERACT Ultrasound Group: A Report from the OMERACT 2016 Meeting and Perspectives

Objective To provide an update from the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group on the progress for defining ultrasound (US) minimal disease activity threshold at joint level in rheumatoid arthritis (RA) and for standardization of US application in juvenile idiopathic arthritis (JIA). Methods For minimal disease activity, healthy controls (HC) and patients with early arthritis (EA) who were naive to disease-modifying antirheumatic drugs were recruited from 2 centers. US was performed of the hands and feet, and scored semiquantitatively (0–3) for synovial hypertrophy (SH) and power Doppler (PD). Synovial effusion (SE) was scored a binary variable. For JIA, a Delphi approach and subsequent validation in static images and patient-based exercises were used to developed preliminary definitions for synovitis and a scoring system. Results For minimal disease activity, 7% HC had at least 1 joint abnormality versus 30% in the EA group. In HC, the findings of SH and PD were predominantly grade 1 whereas all grades were seen in the EA cohort, but SE was rare. In JIA, synovitis can be diagnosed based on B-mode findings alone because of the presence of physiological vascularization. A semiquantitative scoring system (0–3) for synovitis for both B-mode and Doppler were developed in which the cutoff between Doppler grade 2 and grade 3 was 30%. Conclusion The first step has been taken to define the threshold for minimal disease activity in RA by US and to define and develop a scoring system for synovitis in JIA. Further steps are planned for the continuous validation of US in these areas